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To facilitate true collaboration among health care systems, public health, human services and the

nonprofit sector in our community, a community health needs assessment process was developed and

conducted within Lake County. These organizations have aligned their resources, skills, expertise and

interests to collaborate towards a healthier Lake County.

CONTENTS

Lake View Hospital……………………………………………………………………………………………………………………………..3

Progress to Date on 2013 Community Health Needs Assessment……………………………………………………….4

2016 Community Health Needs Assessment Objectives………………………………………………………………………5

Assessment Partners…………………………………………………………………………………………………………………………..5

Process Overview………………………………………………………………………………………………………………………………..6

Phase 1: Assessment…………………………………………………………………………………………………………………………..6

Description of Community Served By Lake View Hospital……………………………………………………………………7

Phase 2: Prioritization……………………………………………………………………………………………………………………….12

Phase 3: Design of Strategy and Implementation Plan………………………………………………………………….……14

Conclusion…………………………………………………………………………………………………………………………………………14

Appendix A: Lake View Hospital Progress to Date……………………………………………………………………………..15

Appendix B: 2012 Carlton-Cook-Lake-St. Louis Community Health Improvement Plan………………………17

Appendix C: Community Organizations Represented in Focus Groups……………………………………………….24

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Lake View Memorial Hospital, Inc. (Lake View) is part of the St. Luke’s system, a comprehensive

regional health care system. The St. Luke’s system offers a comprehensive continuum of care serving the

17-county region of northeastern Minnesota, northwestern Wisconsin and the Upper Peninsula of

Michigan. The system includes St. Luke’s Hospital in Duluth, Minnesota, Lake View Hospital, Clinic and

Urgent Care in Two Harbors, Minnesota, plus 14 primary and 27 specialty clinics, six urgent care

locations and two retail express care clinics. Primary care clinics are located in Duluth, Hermantown,

Hibbing, Two Harbors, Mountain Iron and Silver Bay, Minnesota, and Ashland and Superior, Wisconsin.

In addition, Urgent Care and Q Care express medical services are available. St. Luke's is verified by the

American College of Surgeons and the state of Minnesota Department of Health as a Level II trauma

center.

In addition to family medicine, other specialties include cardiology, cardiac surgery, oncology, OB/GYN,

plastic surgery, pulmonary medicine, allergy, neurosurgery, dermatology, endocrinology,

gastroenterology, infectious disease, internal medicine, surgery, occupational health, orthopedics &

sports medicine, pediatrics, physical medicine and rehab, rheumatology, psychiatry and urology. St.

Luke's Home Care and Hospice Duluth provide services to patients within a 30-mile radius of Lake View

Hospital.

Also, in collaboration with the University of Minnesota Medical School, Duluth campus, St. Luke's is

involved with clinical research activities in the areas of cancer, lung and heart disease through the

Whiteside Institute for Clinical Research.

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2016 COMMUNITY HEALTH NEEDS ASSESSMENT

OBJECTIVES

In conducting the 2016 Community Health Needs Assessment, Lake View collaborated with community

partners to work towards a healthy Lake County and embraced these guiding principles:

• Seek to create and sustain a united approach to improving health and wellness in our community

and surrounding area;

• Seek collaboration towards solutions with multiple stakeholders (e.g. schools, work sites, medical

centers, public health) to improve engagement and commitment focused on improving

community health; and

• Seek to prioritize evidence-based efforts around the greatest community good that can be

achieved through our available resources.

The goals of the 2016 Community Health Needs Assessment were to:

1. Assess the health needs, disparities, assets and forces of change in the hospitals’ shared service

area.

2. Prioritize health needs based on community input and feedback.

3. Design a collective impact-based implementation strategy focusing on a multi-sector

collaborative approach.

4. Engage community partners and stakeholders in all aspects of the Community Health Needs

Assessment process.

ASSESSMENT PARTNERS

The Community Health Needs Assessment (CHNA) was conducted by Lake View and St. Luke’s.

Assessment partners included stakeholders from community organizations working to improve health

outcomes and reduce inequities. These partners assisted in developing the community-centered process

and community dialogues as well as prioritizing community needs. They also will help build the

implementation plan through a collective impact model.

Lake View partnered with Generations Healthcare Initiatives and a large number of other stakeholders

across Northeast Minnesota and Northwest Wisconsin to conduct the Bridge to Health Survey to provide

local and regional data utilized in this needs assessment.

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PROCESS OVERVIEW

The community health needs assessment was conducted in four stages: assessment, prioritization,

design and finalization. Through each phase of the assessment process, a collaborative community

assessment team was asked to review the data, prioritization and results of community focus groups to

maximize the relevance of the assessment. This group included representation from Lake View, St.

Luke’s, Lake County Public Health and Human Services, the Carlton-Cook-Lake-St. Louis Community

Health Board, Lake Superior School District and non-profit organizations that work with underserved

communities in Lake County or in the area served by Lake View Hospital.

Lake View started the process in May 2016 and completed it in October 2016. The Community Health

Needs Assessment will be presented to Lake View executive team and the Board of Directors in October

2016.

Assessment Process

PHASE 1: ASSESSMENT

The first phase in the process included the collection and review of data in order to provide stakeholders

with a systematic review of the health of community members. This process fosters a deeper

understanding of the demographics and health status of Lake County as compared to the rest of the

region, state and nation. This process also was designed to assist stakeholders in focusing on data-driven

opportunities for improvement in the identified priorities.

Throughout this assessment, it was imperative to view the health needs of the community through the

lens of the social determinants of health. The social conditions in which we live, work and play have

more of an impact on our life expectancy and total health than the medical care we receive. The model

by the University of Wisconsin Population Health Institute, Figure 1, estimates that social and economic

factors may have a larger impact (40%) than either clinical care (20%) or individual behavior (30%). The

themes in this assessment directly reflect the community’s definition of health as it relates to their

whole lives, not the medical care they receive within our healthcare system.

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Health Equity” report2 to the legislators on February 1, 2014: “American Indians and African-Americans

in Minnesota experience substantially higher mortality rates at earlier ages.3”

The MDH “Advancing Health Equity” report to the legislators also cites that, “African-American,

American Indian and Hispanic/Latino populations have household incomes that are almost half that of

Asian and white populations.” This is clearly illustrated in this graph depicting the per capita income of

Minnesota residents from the past 12 months in 20124.

Limitations exist in reviewing health outcomes of specific sub-populations (low-income, people of color,

Native Americans) due to the region’s rural nature and the data for populations smaller than county

level frequently being unavailable or of limited value. Therefore, much of the assessment data are

presented at the county and state level to ensure stability of the estimates. When available, ZIP code or

U.S. Census tract level data will supplement the county-level information to provide a deeper

understanding of the health needs of the community.

Data Collection and Review

Lake View did not directly collect primary data, but partnered with many other stakeholders on the

regional 2015 Bridge to Health Survey. The hospital collected, reviewed and evaluated existing public

health data to support key indicators focused on aspects of health, wellness and the social determinants

of health. These datasets included information from:

United States Census Bureau

This dataset provided internal and external stakeholders with the basic demographics of Lake County.

Data utilized included:

● Demographic breakdown of Lake County: age, gender, race

● Socio-economic status: income, education

Minnesota County-Level Indicators for Community Health Assessment

2 http://www.health.state.mn.us/divs/chs/healthequity/ahe leg report 020414.pdf 3 Mortality disparity ratio is calculated by dividing the rate for a given population by the White rate. Source: MDH, Center for Health Statistics. 4 Source: 2012 Census ACS 1 year, B19301 (race alone)

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This Minnesota Department of Health dataset consists of data related to multiple indicators from

several MDH sources to assist local health departments and community health boards with their

community health assessments and community health improvement planning processes. These datasets

are a standard set of indicators to compare across the Arrowhead Region of Minnesota. Data was

reviewed from:

● Minnesota Student Survey Selected Single Year Results

● 2011 Minnesota County Health Tables

● 1991-2010 Minnesota Vital Statistics State, County and CHB Trends

● Minnesota Public Health Data Access

CDC Behavioral Risk Factor Surveillance System (BRFSS)

This dataset provided an opportunity for comparison of the health outcomes and health status in Lake

County from local surveys to state and national averages for the same questions.

Carlton-Cook-Lake-St. Louis County Community Health Board Community Health Improvement Plan

(CHIP)

In 2012, the Carlton-Cook-Lake-St. Louis County Community Health Board gathered diverse data sources

and conducted community assessment meetings, which included prioritization, to shape a shared vision

for a healthy region. This collaborative effort identified priority areas needing attention across the

Community Health Board’s geographical region and built a foundation for future collaborative work

amongst community partners. The Community Health Improvement Plan serves as a guide for Carlton-

Cook-Lake-St. Louis County Community Health Board on how local health boards, hospitals, health

plans, clinics and other community organizations will focus and align their work to improve the health of

the population and communities they jointly serve. Priorities identified through this process included:

1. Obesity

2. Mental Health

The Carlton-Cook-Lake-St. Louis County Community Health Board CHIP also includes an additional focus

on health inequity and the opportunities to work with communities experiencing greater health inequity

as related to the higher burden of both obesity and mental health issues. The 2012 CHIP can be found in

Appendix B.

2015 Bridge to Health Survey

Based on the 2015 Bridge to Health Survey5, families living at 200% of poverty or less have a self-

reported lower perceived health status, report higher rates of mental health problems, report a higher

incidence of rarely to never getting the social and emotional support they need, have higher obesity

rates, eat less fruits and vegetables, exercise less, have higher tobacco use rates and often worry that

food would run out.

5 Kjos, S.A., Kinney, A.M., Finch, M.D., Peterson, J.M., Bridge to Health Collaborative (2015). Bridge to Health Survey 2015: Northeastern Minnesota and Northwestern Wisconsin Regional Health Status Survey. April 2016.

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The following table of indicators represents the specific health needs of the community:

Condition or outcome

Indicator Bridge to

Health Survey Result (2015)

Minnesota (Years of

Data)

National (Years of

Data)

Obesity % obese according to BMI from self-reported height

and weight 32.1%

25.5% (2013 BRFSS)

29.4% (2013 BRFSS)

Tobacco use % reporting smoking ≥ 100

cigarettes and currently smoking

13.1% 18.0% (2013

BRFSS) 19.0% (2013

BRFSS)

Physical activity

% that meet either moderate or vigorous

physical activity guidelines of ≥ 5 days/week of ≥ 30

min. moderate OR ≥ 3 days/week of ≥ 20 min.

vigorous

29.0% 52.7% (2013

BRFSS) 50.8% (2013

BRFSS)

Diet % consuming ≥ 5

servings/day of fruits and vegetables combined

28.6% 21.9% (2009

BRFSS) 23.4% (2009

BRFSS)

Mental health Average number of

mentally unhealthy days reported in past 30 days

8.4 2.9 (2013

BRFSS) 3.7 (2013

BRFSS)

Physical health % reporting fair OR poor

health 13.1%

12.4% (2013)

16.7% (2013)

Alcohol use % reporting either binge

OR heavy drinking 33.2% Binge

21.6% Binge 7.1% Heavy

Drinking (2013 BRFSS)

17.4% Binge 6.2% Heavy

Drinking (2013)

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Written Comments from 2013 Community Health Needs Assessment

Neither Lake View or St. Luke’s received any comments on their previous Community Health Needs

Assessment. Any comments would have been taken into consideration in the development of this

report.

Current Community Health Assets in Lake County

Lake County is a community with a vibrant array of work taking place in regards to improving the

community’s health. The implementation plan developed collaboratively will center on the opportunity

for partnership with work already being done by organizations in the community.

The interactive map on Healthy Northland6 provides an opportunity for review of other assets, including

opportunities for recreation, physical activity, healthy food, tobacco-free living resources and overall

health and wellness resources. A continued partnership with Healthy Northland and the coalitions they

work with is vital in addressing the needs of our community’s health. The resources outlined in this asset

map highlight the existing resources within the community that are available to respond to the health

needs of the community. Additional partners and stakeholders will be added to this list as the

implementation plan is developed to address community priorities.

In designing the implementation strategy for this report, further analysis will be done of existing internal

and external resources to improve the health of the community.

PHASE 2: PRIORITIZATION

The assessment follows an iterative process that uses data from a wide range of sources and then

solicits feedback from a broad group of stakeholders. The process began with a comprehensive review

of local demographic and health data to identify health status, health disparities and inequities that

contribute to poorer health outcomes. This included a review of the data available for common risk

factors that contribute to poor health, including obesity, physical inactivity and tobacco use.

The data showed that across multiple measures of health, wellness, and disease prevalence, residents of

color and residents with lower levels of income have poorer health outcomes. Therefore, a health equity

focus is needed to ensure that any strategies developed to improve the health and well-being of all

patients are also effective in reducing health inequities between populations based on race, income and

place.

The collaboration placed a heavy emphasis on taking into account input from persons who represent the

broad interests of the community, specifically individuals from low-income, medically underserved or

6 Healthy Northland, http://www.healthynorthland.org/index split.aspx?w=424&r=/index simple.aspx^id=32~pv=78~pvq=subdivision name=%27Duluth%27~pvc=5000~rnd=zGLa3&l=/active arrowhead/menu panel.aspx^cal=26~prop=11~tow=12, July 2016.

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minority populations and those with a special knowledge or expertise in public health. The collaboration

conducted focus groups in community locations at various times of the day throughout the months of

March and April 2016. A total of 12 focus groups were held with more than 300 total participants. A full

list of organizations represented at the community focus groups can be found in Appendix C.

Participants at the focus groups were presented with background details on the social determinants of

health and information from the 2015 Bridge to Health Survey. They were asked to share their feedback

on these questions:

- What makes you feel healthy in your neighborhood?

- What is working for health in Lake County?

- What is not working for health in Lake County?

Participants were then asked to share what they believed were the top three biggest challenges to

achieving health in Lake County by writing them on post-it notes. These topics were then placed on a

wall within the room and grouped into common themes (e.g. obesity, mental health, access to dental

care). Participants were then asked to prioritize using the dot-voting method based on these criteria:

- What is most important to the community?

- What will have the greatest burden on the community if the problem is not addressed?

- What impacts certain subgroups/populations more than others?

A focus group was held with staff members from Lake County Public Health and Human Services in order

to ensure strong representation from those with knowledge or expertise of public health in our

community.

A community focus group provided the opportunity for community members, business leaders,

healthcare professionals, public health professionals, minority groups, teachers and community-based

organizations to share their input on the overarching health needs of the community. Lake View

compiled the feedback to discussion questions and the results of prioritization and reviewed to

determine if the needs that emerged aligned with Lake View’s mission. The needs were prioritized as

follows:

1. Mental Health

2. Alcohol, tobacco and other drugs

3. Socio-economic disparities based on race and neighborhood

4. Obesity, including lack of access to healthy foods and physical inactivity

Each priority area has multiple aspects in which the hospital will work with community partners and

stakeholders to address. By adopting a collective impact model to improve overall health and wellness in

our community, not all issues will be directly addressed by the hospital, but through a multi-sector

coalition-based approach.

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While the following two themes were frequently discussed topics at the community focus groups, based

on resources available and lack of expertise in the area, the needs that the hospital will not be

addressing include:

1. Housing

2. Transportation

Lake View will work to bring visibility to these issues and share findings with local subject matter

experts.

PHASE 3: DESIGN OF STRATEGY AND IMPLEMENTATION PLAN

The hospital will work together to design an implementation strategy with internal stakeholders as well

as external partners and stakeholders who represent the existing healthcare facilities and resources

within the community that are available to respond to the health needs of the community as identified

in this assessment. This implementation strategy will be reviewed and approved by Lake View’s board of

directors prior to April 15, 2017.

Lake View and St. Luke’s continually review how the resources are best allocated to address the

priorities identified in the Community Health Needs Assessment.

CONCLUSION

As part of a nonprofit health system, Lake View is committed to improving the health of our community.

This needs assessment and implementation plan illustrate the importance of collaboration between our

hospital and our community partners. By working collaboratively, we can have a positive impact on the

identified health needs of our community during each hospital’s individual Fiscal Years 2017-2019. There

are other ways in which the hospitals will indirectly address local health needs, including the provision of

charity care, the support of Medicare and Medicaid programs, discounts to the uninsured and others.

Over the next three years, this collaboration will continue to work with the community to ensure that

this implementation plan is relevant and effective and will make modifications as needed.

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APPENDIX A Lake View Hospital

Progress to Date on 2013 Community Health Needs Assessment

Community Health Needs Assessment Implementation Plan Progress Report

Priority 1: Obesity, physical activity, and nutrition

Lake View Hospital engaged in numerous initiatives to positively impact obesity, physical activity, and

nutrition in Lake County.

Lake View Hospital sponsored the 11th Annual Walking By Water wellness event in 2013. This event featured non-competitive walking routes of one, three, and five miles on the Two Harbors walking trail system to encourage lifelong physical activity for people of all ages. This event also included a 100-mile challenge during the summer months to promote physical activity and training for the event in September. Participants were asked to record their miles walked (or equivalent exercise) each month and they were entered into a drawing at the event if they achieved a total of 100 miles or more. Lake View also offered blood sugar and cholesterol screenings for Walking By Water wellness event participants. General education was provided on these two health topics.

Lake View Hospital continues to participate in various health fairs across our communities. These include the Lake County Employee Health Fair, Cooperative Light & Power Health Fair, and the Stanley LaBounty Employee Health Fair. Blood sugar, cholesterol, and balance assessments are provided to participants free of charge by Lake View. A registered dietitian is available at these events to provide nutrition information and answer client questions. Lake View offered free fitness center memberships to Lake View Fitness Center as door prizes and silent auction items to various community fundraisers and community events in Two Harbors and Silver Bay. These events included the Two Harbors Youth Basketball Program golf fundraiser event, Community Partners annual dinner fundraiser and caregiver event, Silver Bay After-Prom event, and the Voyager Snowmobile Club. The goals of these donation programs were to financially support other community events and to promote general physical activity and wellness in our communities.

Lake View Hospital leased a portion of its clinic property free of charge to the Two Harbors Youth Soccer Club in 2016 to promote increased physical activity and prevention of childhood obesity. This partnership will provide more opportunities for the children in our community to benefit from physical activity and exercise.

Lake View’s Physical Therapy and Fitness Center location in the William Kelley High School in Silver Bay continues to provide access to a variety of high-quality exercise equipment to the community, school students, athletes, staff, and coaching personnel. The staffing and supervision of the fitness center is covered by Lake View Hospital.

Lake View offers free, one-time consultations with a physical therapist or exercise physiologist to set up independent exercise programs in the fitness center. This program is tailored to ensure that individuals are performing safe and appropriate exercise regimens to increase physical activity and prevent obesity. The focus of the consultation is to individualize a fitness program to help the client reach their personal goals, including improved fitness and/or weight loss.

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Lake View hosts free fitness classes. A strength and flexibility class, led by trained community volunteers, is held on Tuesdays and Thursdays. A yoga class, led by a Lake View physical therapist who focuses on flexibility and balance training, is held on Tuesdays. Lake View has offered these classes for the past 5 years.

In 2013 – 2014 as a participant in a Community Transformation Grant (CTG) and a State-wide Health Improvement Program (SHIP) grant, Lake View Medical Clinic developed scripting and processes to capture patients’ Body Mass Index measurements. Appropriate educational resources and referrals are provided as needed.

Lake View contracts with AEOA to provide Meals on Wheels and Senior Dining programs to area seniors. Lake View’s registered dietitian prepares the balanced meals that adhere to the USDA Dietary Guidelines.

Lake View’s registered dietitian participates in local health-related events and serves as a guest speaker on nutrition-related topics. Most recently, she spoke at the Aging Mastery Program (a program co-facilitated by Lake County Public Health and ISD 381 Community Education) and at the Mobile Resource Center in Finland, Minnesota.

A registered dietitian in the hospital provides nutrition assessment and education/counseling to inpatients and their families and/or caregivers. Group nutrition classes are held on a regular basis in the cardiac rehab clinic to provide general information on a variety of pertinent nutrition topics, and individual consultation is also encouraged for those who could benefit from more in-depth nutrition therapy.

Lake View contracts with the Lake County WIC program to provide nutrition education to targeted groups, with priority placed on clients who meet high-risk criteria including being overweight/obese.

Priority 2: Smoking Cessation

Lake View Medical Clinic participated in a CTG/SHIP grant in 2013-2014 that assisted in the development of processes to provide smoking cessation resources through the Call It Quits FAX Referral Program. Referral letters and information were created and integrated into the eClinical Works electronic health record used in the clinic setting.

Lake View Medical Clinic staff participated in area health fairs and provided smoking cessation materials.

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APPENDIX B

2012 Carlton-Cook-Lake-St. Louis County

Community Health Improvement Plan

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